Extracorporeal shock wave lithotripsy effectively fragments urinary calculi in the upper urinary tract and upper ureter. These fragments pass completely by 3 months in 77.4 per cent of the patients with single stones. Risk of obstruction, increased postoperative pain, need for additional urological operations and retained fragments are low for stones less than 1 cm. in size. As the number of stones treated or single stone size increases above 1 cm. the risk for these factors increases. Adjunctive urological surgical management is required in 9 per cent of the patients preoperatively and 8 per cent postoperatively. Only 0.6 per cent of the patients require some type of open operation to resolve the stone problems after extracorporeal shock wave lithotripsy. Hemorrhage, obstruction by fragments, severe pain and urinary infection all constitute known complications and require careful urological management of all patients. Hospitalization averages 2 days after treatment and patients usually return to work within a few days after they are discharged from the hospital.

In a series of 162 cases of surgically resected hyperplastic prostates the incidence of inflammation is 98.1%. Six morphologic patterns of inflammation are described: 1) segregated glandular inflammation, 2) periglandular inflammation, 3) diffuse stromal inflammation, 4) isolated stromal lymphoid nodules, 5) acute necrotizing inflammation and 6) focal granulomatous inflammation. The most common pattern, segregated glandular inflammation, is characterized by intraluminal neutrophils and foamy macrophages and by chronic inflammatory cells in the surrounding stroma. No significant morphological differences are found among groups of cases with positive and negative evidence by culture of bacterial prostatic infection. Quantitative but not qualitative morphologic differences are found between cases of gram-negative infections and infection by gram-positive organisms that often are considered non-pathogens.

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Emphysematous cystitis is an uncommon condition in which pockets of gas are formed in and around the bladder wall by gas-forming organisms. Persons with diabetes, neurogenic bladder and chronic urinary infection are predisposed to the disease. Severity of illness ranges from an asymptomatic condition to life-threatening cystitis. We present 2 cases of emphysematous cystitis. One case was an incidental finding on evaluation of abdominal discomfort with resolution upon removal of predisposing factors. The other patient presented with an acute abdomen that progressed to severe necrotizing cystitis ultimately requiring cystectomy. The initial involvement of the urologist as a consultant is emphasized. A complete review of the literature describes the incidence, various presentations, associated diseases and organisms, pathogenesis, and available methods for diagnosis and treatment reported for this disease. Successful management depends on early diagnosis with correction of underlying causes, administration of appropriate antibiotics, establishment of adequate bladder drainage and surgical excision of involved tissue when required. Early detection and prompt treatment are encouraged.

We performed 126 studies of replicate voiding in 7 individuals and 552 observations in normal, abnormal or treated male populations with a disposable device that measures peak flow and volume voided. These observations have led us to suggest that a voided volume of 150 ml. be used as the minimum acceptable volume for studies of male subjects in which peak flow is used to define normal versus abnormal voiding. At volumes greater than 150 ml. a straight line describes the relationship between volume voided and peak flow as accurately as the previously suggested hyperbolic curve. Increasing age of men again reveals progressive decrease in peak flow rate no matter what volume is voided. Comparison of peak flow rate, volume voided and age by 3-dimensional graphing was attempted but was found unsuccessful for clinical use. However, 3 biaxial linear graphs may be used to chart effectively the 3 parameters (age, volume and peak flow) and thereby judge normality or abnormality of peak flow rate for any age and volume voided.